Provider Demographics
NPI:1265269955
Name:WITHERSPOON, DUA'SHA
Entity type:Individual
Prefix:
First Name:DUA'SHA
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26151 LAKE SHORE BLVD APT 1419
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1156
Mailing Address - Country:US
Mailing Address - Phone:216-258-4078
Mailing Address - Fax:
Practice Address - Street 1:26151 LAKE SHORE BLVD APT 1419
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1156
Practice Address - Country:US
Practice Address - Phone:216-258-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health